No one’s talking about exchange backup plans

Federal and state officials appear to be out of options as far as rebooting HealthCare.gov.

The U.S. Department of Health and Human Services hasn’t discussed contingency plans.

Some state exchange sites have been working reasonably well and, according to officials, have processed close to 100,000 applications since the sites opened for business Oct. 1. But sites in other state-run sites, such as Vermont and Hawaii, also have had trouble taking and processing applications.

Republican critics in the House have written to ask HHS about reports of Web enrollment problems. And some opponents of the Patient Protection and Affordable Care Act have asked consumers not to enroll in 2014 coverage. But no one’s talked much about the mechanics of how consumers will enroll in Medicaid and individual plans in the exchanges without consumers having reliable access.

America’s Health Insurance Plans declined to address exchange problem contingency plans. Karen Ignagni, president of AHIP, and Scot Serota, chief executive officer of the Blue Cross and Blue Shield Association, said Monday in a joint statement that “experienced systems experts from across the industry” are working with exchange managers to address operational issues.

“As the new marketplaces move forward, we’re confident consumers will be able to get the coverage they need,” Ignagni and Serota said.

Health insurers have told policymakers that delaying or killing some PPACA provisions, such as the individual mandate, could expose carriers in the individual and small-group markets to problems with unpredictable swings in claims risk, by interfering with efforts to attract and keep healthy consumers.

Lisa Goldstein and other rating analysts at Moody’s Investors Service have written in a commentary that partial implementation of the PPACA exchange program also could hurt nonprofit hospitals. Medicare and Medicaid program managers have been trying to cut the amount they pay “safety net” hospitals, based on the assumption PPACA programs would sharply reduce the number of uninsured next year.

If exchange enrollment problems persist, “the reduction in the uninsured will materialize more slowly than expected,” the analysts write.

All of the uncertainty will make hospital budgeting challenging, the analysts say.

The parent company of United Airlines and Continental Airlines said Wednesday that Continental has reached a labor agreement with representatives of some 7,200 non-union employees who work as reservation agents and in other passenger-service roles.